Stamm W E, Wagner K F, Amsel R, Alexander E R, Turck M, Counts G W, Holmes K K
N Engl J Med. 1980 Aug 21;303(8):409-15. doi: 10.1056/NEJM198008213030801.
To determine the cause of the acute urethral syndrome, we studied 59 women with dysuria and frequent urination without "significant bacteriuria" (defined as greater than or equal to 10(5) organisms per milliliter), 35 women with typical cystitis and 66 women with no symptoms of urinary-tract infection. Although none of the 59 women with urethral syndrome had greater than 3.4 x 10(4) bacteria per milliliter in either of two successive midstream urine specimens, samples of bladder urine obtained by suprapubic aspiration or catheterization from 24 women contained coliforms, and samples from three contained Staphylococcus saprophyticus; all but one of these 27 women also had pyuria. Of the 32 women with sterile bladder urine, 10 of 16 with pyuria and one of 16 without pyuria were infected with Chlamydia trachomatis (P = 0.002). Chlamydial infection was found in 11 of 42 women with urethral syndrome and pyuria, in three of 66 without symptoms, and in one of 35 with cystitis (P less than 0.01 when the group with urethral syndrome is compared with either of the other groups). Thus, 42 of 59 women with urethral syndrome had abnormal pyuria and 37 of these 42 were infected with coliforms, S. saprophyticus, or C. trachomatis, whereas few women without pyuria had demonstrable infection. Bacteriuria of greater than or equal to 10(5) per milliliter may be an insensitive diagnostic criterion when applied to symptomatic lower-urinary-tract infection.
为了确定急性尿道综合征的病因，我们研究了59例有排尿困难和尿频但无“显著菌尿”（定义为每毫升尿中细菌数大于或等于10⁵个）的女性、35例典型膀胱炎女性以及66例无尿路感染症状的女性。尽管59例尿道综合征女性中，连续两次清洁中段尿标本中细菌数均未超过每毫升3.4×10⁴个，但通过耻骨上穿刺或导尿获取的24例女性膀胱尿标本中含有大肠菌，3例含有腐生葡萄球菌；这27例女性中除1例之外均有脓尿。在32例膀胱尿无菌的女性中，16例有脓尿的女性中有10例、16例无脓尿的女性中有1例感染沙眼衣原体（P = 0.002）。在42例有尿道综合征且有脓尿的女性中，11例发现有衣原体感染；在66例无症状女性中，3例发现有衣原体感染；在35例膀胱炎女性中，1例发现有衣原体感染（尿道综合征组与其他任何一组相比，P<0.01）。因此，59例尿道综合征女性中有42例脓尿异常，这42例中的37例感染了大肠菌、腐生葡萄球菌或沙眼衣原体，而脓尿正常的女性中很少有可证实的感染。每毫升尿中细菌数大于或等于10⁵个这一菌尿标准应用于有症状的下尿路感染时可能是一个不敏感的诊断标准。
